Provider Demographics
NPI:1912237553
Name:SARVIDE, JORGE F (LAC)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:F
Last Name:SARVIDE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RIVERTON DR.
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:510-967-4171
Mailing Address - Fax:
Practice Address - Street 1:133 W 72ND ST
Practice Address - Street 2:SUITE 704
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3235
Practice Address - Country:US
Practice Address - Phone:510-967-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004644171100000X
CA13138171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist